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Ketamine got its start in Belgium in the 1960s as an anesthesia medicine for animals. The FDA approved it as an anesthetic for people in 1970. It was used in treating injured soldiers on the battlefields in the Vietnam War. Emergency responders may give it to an agitated patient who, for example, they have rescued from a suicide attempt. That’s how Ken Stewart, MD, says doctors began to realize that the drug had powerful effects against depression and suicidal thoughts.
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Fast-acting formulations of ibuprofen, and those combining ibuprofen plus caffeine were the next most effective, with success rates of between 50% and 60%. Paracetamol alone had a success rate of 43% at doses of 500mg but larger doses were less effective. Aspirin was the least effective pain killer overall, with a success rate of only 11%. There were no clinical trials to show how well codeine or dihydrocodeine worked in this particular analysis. Only a few products include the combination of ibuprofen and paracetamol (acetaminophen), however, such as Nuramol which is available from pharmacies in the UK.
Tramadol is sometimes prescribed as a second-line medicine to patients with neuropathic pain,8 although the evidence supporting this practice is weak.9 It is recommended to use a validated tool, such as the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), to diagnose or exclude neuropathic pain. If neuropathic pain is present, the first-line pharmacological options would be a tricyclic antidepressant, gabapentin* or carbamazepine, which may be used in combination with an analgesic for nociceptive pain. In this scenario, it may be reasonable to select tramadol, in preference to codeine or dihydrocodine, if a Step 2 analgesic is required. As with any opioid, tramadol should be used for the shortest possible time, at the lowest effective dose, with a plan in place to reduce and withdraw treatment. Tramadol may have less potential for misuse and dependency than other opioids as it is an atypical analgesic, however, the same prescribing cautions should be applied to tramadol as to other opioids to minimise the risk of inappropriate use.
We also asked parents about other things they wished their prescribing physician had done. While 43 percent didn’t express any concerns with the physician prescribing ADHD medication for their child, 29 percent said they wished the physician would “welcome their input about their child more than he/she currently does.” Twenty-six percent said they wished doctors would “provide information about any financial relationships he/she may have with companies that sell ADHD medications,” and 25 percent said they wished doctors would “discuss the long-term safety of prescription medications for my child.” Parents didn’t rate doctors well for managing their child’s medication. “Patients or families should call whenever they have questions about a medication,” Goldstein urges. He offers these additional tips: Always call the doctor with questions. Even if all is well, check in by phone two weeks after beginning medication and schedule a visit one month after for a follow-up. After that, return visits will depend on the success of the treatment and side effects. In general, children doing well can be seen every six months.
Zaleplon ( Sonata ): Of all the newer sleeping pills, Sonata stays active in the body for the shortest amount of time. That means you can try to fall asleep on your own. Then, if you’re still staring at the clock at 2 a.m., you can take it without feeling drowsy in the morning. But if you tend to wake during the night, this might not be the best choice for you.
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